Importancia epidemiológica del diagnóstico temprano en el manejo de sífilis gestacional y congénita, falla terapéutica del tratamiento secundaria a demora en el diagnóstico / Epidemiological importance of early diagnosis in the management of gestational and congenital syphilis, treatment failure secondary to delay in diagnosis

La sífilis, enfermedad legendaria, tiene formas asintomáticas y sintomáticas; sus formas de presentación son diversas y dependen de la localización y la extensión de las lesiones. Cuando se presenta en la mujer embarazada se clasifica como sífilis gestacional, con alto impacto en salud pública y con consecuencias graves, como aborto, mortinato o parto prematuro con producto enfermo. La recomendación actual del tratamiento en gestantes es la penicilina G benzatínica, 2,4 millones de unidades en dosis única o hasta 7,2 millones de unidades en tres dosis con intervalos de una semana. La evidencia hasta el momento en mujeres gestantes que presentan sífilis latente con neurosífilis o sin ella, tratadas con penicilina, ha mostrado falla terapéutica sin importar qué esquema se prescriba, esto debido a múltiples eventos tanto técnicos como de acceso. En la revisión del caso clínico de una paciente de 29 años de edad, negativa para VIH, primípara y con abandono del control prenatal, con embarazo de 29 semanas en el momento del diagnóstico de sífilis gestacional; se evidenció falla terapéutica con penicilina G benzatínica, secundaria a la falta de controles prenatales tempranos con retraso en el diagnóstico. Se identificó en el posparto, con niveles de serología reactivos y producto con sífilis gestacional.

Syphilis, legendary, has forms of asymptomatic and symptomatic; their presentations are diverse and depend on the location and extent of injuries. When it occurs in pregnant women it is classified as gestational syphilis, with high impact on public health and serious consequences, such as abortion, stillbirth or premature birth with diseased product. The current recommendation of treatment in pregnant women is penicillin G benzathine, 2.4 million units in a single dose or up to 7.2 million units in three doses at intervals of one week. The evidence so far in pregnant women with latent syphilis neurosyphilis or wrongly, treated with penicillin, has shown therapeutic failure no matter what scheme are prescribed, due to multiple events both technical access. In the review of the clinical case of a 29-year-old, negative for HIV in her first gestation and abandonment of antenatal care, with 29 week pregnancy at the time of diagnosis, gestational syphilis; evidenced therapeutic failure with penicillin G benzathine, secondary to lack of early prenatal with delay in diagnosis. It was identified in the post-partum, with levels of serology reagents and product with congenital syphilis.

Nonimmune hydrops fetalis due to congenital syphilis associated with negative intrapartum maternal serology screening.

We present an unusual case, in which a woman presenting with markedly decreased fetal movements at 29 weeks gestation following a recent increase in fundal height was noted sonographically to have fetal hydrops consisting of scalp edema, marked hepatomegaly, ascites, and polyhydramnios. No lethal structural congenital anomaly was noted. Admission laboratory examinations revealed a negative antibody screen and a negative RPR. Emergent cesarean section was performed due to prolonged fetal bradycardia during biophysical profile testing. The acidotic hydropic neonate weighing 1825 g was resuscitated yet succumbed at 3 hr of life following intravenous administration of antibiotics. Neonatal blood was RPR positive at 1:16. Postmortem pathology examination demonstrated severe multiorgan system failure secondary to overwhelming congenital syphilis. Extensive extramedullary hematopoiesis was noted and histopathology with Dieterle stains revealed numerous hepatic spirochetes. Postpartum reexamination of the maternal blood with serial dilutions revealed a positive RPR at 1:1024. This case emphasizes that initial negative screening for syphilis may be seen despite overwhelming infection, a condition that has been termed the "prozone effect."

Congenital syphilis in aborted second trimester fetus: diagnosis by histological study.

A case of congenital syphilis in an aborted fetus in the second trimester of pregnancy was documented by demonstration of spirochaetes in the fetal liver, despite the fact that diagnostic studies had not been performed on the mother. Suspicion was aroused by the gross and microscopic appearance of the placenta, which appeared identical with the described in proven cases of congenital syphilis. Although these changes have been alleged to be non-specific, the rarity with which such well-developed lesions are encountered in placentas in other circumstances dictates the necessity for further study when they are observed.